www.starkstate.edu/ce
330-966-5455
Continuing Education Center
265 East Maple Street, North Canton
Spring 2014 class schedule
WORKFORCE AND ECONOMIC DEVELOPMENT
L e a r n
Business/Management
Quality System Audit Training
This comprehensive training covers all aspects
of ISO 9001:2008 and process auditing. Our
12-hour course is designed for aspiring auditors
and anyone else with a need to understand the
requirements of a quality management system
and the basic skills needed to audit, manage, or
implement it.
Instructor: Jim Linkie, RABQSA, MSSC
CRN: 40048
Wednesdays, March 5 - 26
4:30 - 7:30 p.m.
Fee:$450
This class can also be scheduled for a group of
six or more at a discounted rate.
Elite G.O.A.L. Attainment
Create radically empowering changes in your
life, your relationships or your career. Get
rid of to-do lists and gear up for a powerful,
interactive, goal-setting workshop. Professional
success coach and life strategist Dominic
LaFay will guide you through an individualized
goal achievement process that gets results.
You’re going to walk away confidently with the
essential Results Code process to get ahead in
your life, personally and professionally, mastery
of the ultimate determining factor for improving
the quality of your life’s results, the guide to
doubling your personal productivity overnight
and a written plan for immediately turning your
goals into your reality.
(Also approved by BELTSS for 4 CE hours.)
Instructor: Dominic LaFay
CRN:40035
Saturday, March 22
8:30 a.m. - 12:30 p.m.
Fee:$49
OTHER BUSINESS COURSES
AVAILABLE ONLINE
> Creating a Successful Business Plan
> Project Management Applications
> Managing Customer Service
> Supply Chain Management
Fundamentals … and many more
DETAILS: www.ed2go.com/ssct
t o d a y ,
s u c c e e d
Skills for Effective Supervisors
Designed for first-line supervisors who want
to enhance the skills necessary to get the job
done in a changing environment, this noncredit
course is structured to address registrants’
specific needs. Sample topics include
organizational culture, planning and leading,
appraisal of employee performance, improving
departmental productivity, goal setting, dealing
with change, and problem solving.
Text required.
Instructor: Frank Tinus
CRN: 40036
Thursdays
February 20 - April 10
(no class March 13 and 27)
4:30 - 7:30 p.m.
Fee:$289
[NEW!] Root Cause Analysis-Team
Problem Solving
You’ll leave with an understanding of how to
identify the real reason a problem exists, what
problem-solving tools are available, how to
create effective actions and approach problem
solving as a team. This is a great start to
becoming a skilled problem solver.
Instructor: Jim Linkie, RABQSA, MSSC
CRN: 40049
Wednesday, February 19
4:30 - 8:30 p.m.
Fee:$140
Organizations may request a specific date and
time at their site for a group of eight or more.
Coaching and Mentoring
Discover how to successfully coach and guide
your team members in
• motivation theory and practice
• coaching for optimal performance
• bringing out the best in others
• building a collaborative relationship with
your peers
• tools and techniques of effective mentoring.
(Also approved by BELTSS for 6 CE hours.)
Instructor: Dominic LaFay
CRN: 40034
Tuesdays, April 22 and 29
4:30 pm - 9:30 pm
Fee:$89
t o m o r r o w .
[ Online Course ]
CMA Exam Part I Review This online course covers all of the topics
tested on part one of the Certified Management
Accountant (CMA) exam. We’ll cover planning,
budgeting and forecasting; performance
measurement; cost management; internal
controls; and professional ethics, and you’ll be
prepared to sit for part one of the CMA exam.
We offer this course both for college credit and
as continuing education. Course fee includes
IMA study materials and access to the IMA
online learning center. Online access instructions will be provided at registration.
Instructor: Pamela Benner, MBA, CMA
CRN:40024
January 14 - May 12
Fee:$750
Ohio Insurance Pre-Licensing Courses
> Life > Health > Property > Casualty
State Requirements
Resident candidates for a State of Ohio agent
license in life, health, property and casualty
insurance must complete either a 20-hour
classroom course or an online self-study course
before taking the state’s licensing examination
administered by Promissor. Stark State College
is an approved provider of self-study courses.
Ohio Revised Code requires all resident
applicants to pass a criminal background check
conducted by the Ohio Bureau of Criminal
Investigation and Identification.
Online self study
To access our online self-study courses,
go to www.starkstate.edu/ce and click on
online self-study under insurance pre-licensing.
Choices available
Standard course - $129.95
Flex package - $149.95
(includes online flashcards and MP3 audio files)
Advantage package - $194.95
(includes PASS study guide and audio CD)
1
Counselors
Social Workers
Nursing Home Administrators
Occupational Therapists
from Toy Story and other popular Hollywood
films, and we’ll engage in group discussions.
Presenter: Linda Davis, PhD,PC, LSW
CRN: 40058
Friday, May 16
8:30 a.m. - 4 p.m. Fee: $119 (includes lunch)
The State of Ohio Counselor, Social Worker and
Marriage Family Therapist Board has approved
Stark State College as a provider of continuing
education (#RCS069401). The Ohio Board of
Nursing The Board of Executives of Long-Term
Services and Supports (BELTSS- formerly
BENHA), and Occupational Therapy, Physical
Therapy, and Athletic Trainers (OTPTAT) Board
also recognize the assigned continuing education units. Each workshop, unless indicated
otherwise, will provide six contact hours of
continuing education.
Getting Up and Out: Practical Help for
Depression
What Can Homer Simpson Teach Us
About Ethics?
This workshop will explore the multi-faceted
issues around ethics using the popular cartoon
The Simpsons, and other Hollywood films.
These media clips will aid in presenting and
discussing ethical situations. You will become
familiar with ethical and personal issues so that
these issues will become conscience areas for
further development and exploration. We will
also discuss a number of ethical dilemmas and
develop accepted means for confronting and
dealing with ethically difficult or demanding
situations. 3 CEUs
Instructor: Linda Davis, PhD, PC, LSW
CRN:40068
Friday, March 14
1 pm - 4:15 pm
Fee:$59
Supervision: Clinical and Leadership
Development
Effective supervision will help you become
a leader others will follow. In this workshop
we’ll explain models of supervision, skills to
strengthen supervisory relationships, distinct
issues that arise in supervision and the role
of evaluation. This workshop is designed to
satisfy the Counselor, Social Worker, Marriage
and Family Therapist Board’s designation for
training supervision, as well as benefit others
in supervisory roles.
Instructor: Judi Fischer, MA, LPCC
CRN:40057
Friday, April 4
8:30 a.m. - 4 p.m.
Fee: $119 (includes lunch)
Lessons from Woody: Addressing
Recurring Mental Health Issus in Families
This workshop will identify mental health
disorders prevalent in counseling and social
work. The Diagnostic and Statistical Manual’s
criteria will be presented on childhood ADHD
and oppositional defiant disorder, adult
adjustment disorder and depression, and PTSD,
which affects both children and adults. The
DSM’s statistical data, categories, and criteria
will be presented along with a critical analysis
of each of the disorders through case examples
2
This workshop will begin with a review of the
symptoms and criteria for clinical depression,
and introduce eight risk factors that every clinician should be aware of. Participants will define
goals for assessment, as well as explore a
variety of modalities for patient treatment. The
session will culminate in addressing thinking
patterns which contribute to depressive thinking, and discussing a practical approach for
treatment and management of the diagnosis.
Instructor: Judi Fischer, MA, LPCC
CRN:40059
Friday, May 2
8:30 a.m. - 4 p.m.
Fee: $119 (includes lunch)
Games and Other Therapies
One of the ways to connect with children,
to learn about them and help them grow in
psychotherapy is to play with them. Luckily, it’s
fun and it’s what most kids do well. But play is
more than fun, and can involve so much more
than dolls, clay, blocks, and art supplies. You
will discover various types and functions of
play in therapy. We will give special attention to
the use of games, along with more traditional
expressive/enacting play therapies.
Presenter: Jim Foley, MSW, MISW
CRN: 40056
Friday, April 11
8:30 a.m. - 4 p.m. Fee: $119 (includes lunch)
Medical/Health Care
[NEW!] Certified Dietary Manager
An in-depth program which includes 126 hours
of classroom instruction and 150 hours of
supervised field experience in a pre-approved
work setting including focus in food service
operations, safety and sanitation, dietary
operations delivery and nutrition and medical
nutrition therapy. Twenty-five hours of the
45 hours of nutrition experience must be
supervised by a registered dietitian. All field
experience sites meet the requirements of
the Association of Nutrition and Foodservice
Professionals (ANFP). Registrants must be high
school graduates or equivalent actively working
in a healthcare facility, and are responsible
for coordinating their work experiences with
an approved preceptor. For more information
about credentialing, visit www.anfponline.org or
call ANFP at 800-323-1908. This class meets
the requirements needed to sit for the national
certification examination.
Required textbooks are available at the Stark
State College Store or may be purchased
w w w. s t a r k s t a t e . e d u / c e
from ANFP online with the school code.
The ServSafe text may be purchased from
ServSafe.com or Paster/Training.com.
Instructor: Mary Merda, RD., LD and
Deborah Kemokai-Wright,
RD., LD
CRN: 40001
Friday, January 10 - May 30
9 am - 5 pm
Fee:$900
(Students may bring their own lunch, snacks
and beverages.)
Nurse Aide/Home Health Aide Training
This training program prepares you to function
in a traditional nursing assistant role in nursing
centers or as a home health aide. The course
includes 16 hours of clinical training and 59
hours devoted to lecture and skills laboratory
practice. Topics include observation skills,
universal precautions for infection control,
basic elements of body functioning, recognition of emergencies, physical, emotional and
developmental, appropriate and safe techniques
in personal needs of patients, and hygiene
and grooming. You’ll be eligible to take the
nursing assistant state competency test or you
may seek employment as a home health aide.
Attendance policy in accordance with the Ohio
Department of Health states no absenteeism is
permitted within the first 16 hours of instruction. Class requirements include a current
physical exam report along with a negative
TB test or negative chest x-ray, a background
check and liability insurance available through
the college. Text required.
Instructor: Marilyn Freer
CRN: 40054
Monday/Wednesday/Friday
February 3 - 28
(no class Feb. 17)
9 a.m. - 4:30 p.m.
Fee:$599
— OR —
CRN: 40055
Tuesday/Thursday/Saturday
March 4 - April 17
Tuesdays and Thursdays,
6 - 9 p.m.;
Saturdays, 9 a.m. - 3:30 p.m.
Fee:$599
OTHER HEALTH COURSES
AVAILABLE ONLINE
> Introduction to Natural Health and
Healing
• Handling Medical Emergencies
• Certificate in End of Life Care
• Complementary and Alternative
Medicine …and many more
DETAILS: www.ed2go.com/ssct
Pharmacy Technician Training Program
This course is designed to prepare individuals
who want to enter the pharmacy field in
hospitals, home infusion pharmacies or
retail pharmacies under the supervision of a
registered pharmacist. When you complete this
course you may register to take the pharmacy
technician certification exam to become a
certified pharmacy technician. Key topics are
• medical terminology, reading and interpreting prescriptions
• generic and brand names of drugs
• dosage calculations and dose conversions
• dispensing of prescriptions, unit doses and
inventory control.
Course fee includes textbooks and certification
exam preparation software. Basic math assessment required for admission to the program.
Instructor: Janice Sprankle, PT
CRN:40026
Tuesdays
January 14 - April 29
(no class March 11)
5 - 8 p.m.
Fee: $699
CPR-AED
This course will prepare you to become
certified in American Red Cross Professional
Rescuer/AED. You’ll master CPR/AED on Adults,
Children, and Infants. There will be demonstrations on procedures for rescue breathing,
conscious choking, and unconscious choking.
The required textbook and mask is available for
purchase at the college bookstore.
Instructor: Irene Dobko
CRN:40025
Saturday, February 22
8:30 a.m. - 1:30 p.m.
Fee:$35
[ Additional CPR classes will be
offered in May 2014 ]
Veterinary Assistant Training
Do you love animals? Would you like caring for
them? Get trained for entry-level employment in
a veterinary clinic or office. Topics will include
• animal restraint and control
• patient care
• inoculation procedures
• basic laboratory skills
• assisting in surgery
• front desk operations
Monday and Wednesday classes will be at
Stark State’s Continuing Education Center;
two individually scheduled Saturday
classes will be at Elm Ridge Animal
Hospital in Canal Fulton.
Instructor: Melanie Butera, DVM
CRN: 40014
Mondays/Wednesdays
January 13 - March 26
(no class weeks of January 20
and March 10)
6:30 - 9 p.m.
Fee: $699
NACE Exam Prep - Nursing Care of
Children
With review of pediatric nursing information,
this class will assist and guide licensed practical nurses in studying for the National League
for Nursing NACE Nursing Care of Children test.
Students are encouraged to buy and bring to
class the recommended review book sold in the
bookstore.
Instructor: Sheryl Stuck, MSN, RN
CRN:40053
Friday, January 10
9 a.m. - 3:30 p.m.
Fee:$69
[NEW!] Open Lab for ICD-10-CM/PCS
This is an open lab resource to aid certified
medical coders (CCA, CPC-A, CCS, CCS-P,
RHIT, and RHIA) in the transition from
ICD-9-CM to ICD-10-CM/PCS. The open lab
offers authentic medical records, 3M Integrated
Codebook and access to the Coding Handbook.
Attendees will have access to ancillary (labs,
x-rays, MRI, CT scans, etc.), emergency
department, surgery, and inpatient health
records. This is a lab experience that allows
the certified coder access to different types of
genuine patient health records to code at their
own speed, and audit their code assignment
against provided answers. An ICD-10-CM/PCS
Train-the-Trainer certified coder will assist with
encoder access and use.
This open lab resource is highly suggested for
only certified coders who have some training in
ICD-10-CM/PCS and wish to practice on actual
medical records.
Instructor: Terrie Bradshaw, ICD-10-CM/
PCS Train-the-Trainer Certified
CRN:40060
Saturday, April 5
8 a.m. - noon
Fee:$54.95
Dental
Medical Emergencies for the Dental
Professional
This four-hour course provides information on
the recognition of common medical emergencies, and emergency protocol including prevention, management and response in a dental
office setting. Participants will learn to identify
potential risks for emergencies reported in the
medical and dental histories of their patients.
Recognition of symptoms, first aid treatment
and possible outcomes for patients in emergency situations will be discussed. This course
meets the guidelines as outlined in the statutes
of the Ohio Dental Practice Act required for a
dental hygienist to practice when the dentist is
not physically present in the office.
Instructor: Lisa Welch, RDH, MS
CRN:40011
Saturday, March 8
8 a.m. - noon.
Fee:$125
Expanded Functions Dental Auxiliary
(EFDA) Clinical Board Review Course
This hands-on lab course is designed to further
prepare an applicant for the EFDA certification
exam administered by the Commission on
Dental Testing in Ohio, Inc. Besides offering
further clinical practice and instruction in EFDA
techniques, this course meets remediation
requirements for applicants who have not
successfully passed the Ohio EFDA clinical
certification exam after two attempts. Clinical
practice and instruction will be provided
through lab review and practice. Course participants will have the added benefit of a mock
board simulation experience. Students must
have successfully completed an approved
training program prior to seeking admission into
this review course. Students wishing to take
this course to meet Ohio Commission remediation requirements should be prepared to provide
paperwork stating specific exam deficiencies
to the course instructor prior to the first day of
class. Lunch provided.
Instructor: Nancy Woodruff, RDH, EFDA, BS
CRN: 40009
Saturday and Sunday
May 3 and 4
9 a.m. - 4:30 p.m.
Fee:$525
CDA Exam Preparation
This continuing education course is designed
for dental assistants interested in reviewing for
the Dental Assisting National Board Examination (DANB) and/or the Ohio Dental Assisting
Certification exam (CODA). This review course
offers candidates preparing for the national or
state dental assisting certification exam a face
to face interaction that includes review, discussion and a question/answer session on each
examination subject area. The 4.5 hour course
will review dental anatomy, dental radiography,
and infection control subject areas necessary
for preparation for the examinations. A packet
containing PowerPoint presentation(s) and
sample test questions will be provided to each
participant. No textbook is required, however
supplemental review books for the dental
assisting certification exams will be available
and discussed.
Instructor: Kelli DeCarlo, RDH, MS
CRN: 40005
Saturday, March 22
8 a.m. - 12:30 p.m.
Fee:$129
3
Oral Health Access Provider
This course will prepare dental hygienists to
properly and safely practice dental hygiene
under the oral health access supervision
program (OHASP). We’ll cover the basic
concepts that allow a dental hygienist to
provide dental hygiene services to patients
when the oral health access supervising dentist
is not present. This eight-hour course will cover
topics such as treatment of geriatric, medically
compromised, developmentally disabled and
pediatric patients; common oral conditions;
medical considerations; medications; behavioral
management; recognition of abuse; recognition
of what constitutes a medically significant
change to a patient’s medical or dental
history; infection control; and ethical and legal
considerations. As required by 4715.372(B)(2)
(b) of the Revised Code, the course will include
all recordkeeping practices outlined in board
rule 4715-9-01, and those pertaining to the
OHASP as stated in 4715.361 to 4715.375 of
the Revised Code and will be inclusive of all
forms required by the board in association with
the OHASP. Lunch provided.
Instructor: Nancy Stanwick, RDH, MS
CRN:40012
Saturday, April 12
8 a.m. - 5 p.m.
Fee:$395
Dental Assistant Clinical Exam Review
This course is designed for dental assistants
who are interested in reviewing for the
clinical portion of the Ohio Dental Assisting
Certification exam (CODA). This review course
allows dental assistants studying for the state
certification exam a face-to-face experience
that includes review and clinical practice in the
techniques of various assisting duties including:
types of dental materials, radiography exposure/mounting, instrument identification, and
practical patient management skills necessary
for the CODA exam. No textbook is required,
and supplemental review and reference
textbooks for the Dental Assisting Certification
exam will be discussed. Lunch provided.
Instructor: Jill Kohler, RDH, BS
CRN:40007
Saturday, April 26
9 a.m. - 4 p.m.
Fee:$250
Coronal Polishing for the Certified
Dental Assistant
This self-study and hands-on course teaches
basic anatomy, exposure control procedures,
and indications and contraindications for
coronal polishing. You’ll complete a two-hour
online module prior to the first day of the
class. Online you’ll learn the basic concepts to
prepare for the five-hour face-to-face lecture
and clinical practice session. You’ll practice
and demonstrate appropriate coronal polishing
techniques on anatomical models and on a
fellow student (liability form must be received
prior to course delivery). Appropriate certification by DANB or the Ohio Commission on Dental
Assisting required. You can access the online
course and contact course instructors using the
login provided. Course modules will be available
one week before the start of the clinical portion.
Registration will end one week prior to the class
start date. Lunch provided.
Due prior to the first clinical session
• Copy of appropriate CDA certificate (DANB
or Ohio CODA)
• Copy of current BLS certification
• Proof of HepB vaccination/immunity
• Signed liability form
*Information about these items is available online. You
can access the online course content and contact the
course instructors one week prior to the delivery of
the face to face portion of this course using the login
provided. Students will not have access to course
content prior to this time.
Instructor: Sheri Herbert
CRN: 40006
Saturday, February 8
9 a.m. - 2:30 p.m.
Fee:$395
Dental Sealants for the Certified Dental
Assistant
This course meets the guidelines outlined in
the statutes of the Ohio Dental Practice Act
for sealant application by certified dental
assistants in Ohio. You will receive one hour
of online didactic instruction, followed by one
hour face to face review prior to written exam.
The didactic portion will focus on terminology,
anatomy, exposure control, dental materials
and placement procedures and six clinical
hours of demonstration, practice, and clinical
competency of sealant placement. During the
six hour lab practice session, students will
practice and demonstrate appropriate sealant
application techniques on anatomical models
and typodonts and a fellow student. Appropriate
certification by DANB or the Ohio Commission
on Dental Assisting required. Registration will
end one week prior to the class start date.
Lunch provided.
Due prior to the first clinical session
• Copy of current CDA certificate (DANB
or Ohio)
• Copy of current BLS certification
• Proof of HepB vaccination/immunity
• Signed liability form
*Information about these items is available online. You can
access the online course content and contact the course
instructors one week prior to the delivery of the face to face
portion of this course using the login provided. Students will
not have access to course content prior to this time.
Instructor: Jill Kohler, RDH, BS
CRN: 40008
Saturday, April 5
9 a.m. - 4:30 p.m.
Fee:$395
Local Anesthesia for the Dental Hygienist
This self-study, lecture and hands-on course
prepares dental hygienists in Ohio for the safe and
effective administration of local anesthesia and
pain control. Topics include anatomy, physiology,
pharmacology of local anesthesia, administration
of local anesthesia, and indications, precautions
and limitations associated with the use of local
anesthesia. You’ll first complete a 12-hour online
module, followed by a three-hour lecture and 14
hours of clinical practice in the techniques of local
anesthetic administration on anatomical models
and lab partners. You are required to serve as participant partners during the clinical training portion
of the course. Completion of this course prepares
you to take the NERB examination required for
dental hygiene local anesthesia credentialing in
Ohio. This course is approved by the Ohio State
Dental Board and meets the standards for dental
hygienists to be able to administer local anesthesia
in the state of Ohio. It will be held in the Stark State
College Dental Hygiene Clinic under the supervision
of a dentist and qualified dental hygienist faculty.
Registration will end two weeks prior to the class
start date. Lunch provided.
Course participant requirements
• purchase of required textbook from college
bookstore prior to completing online module
• completion of online learning modules according
to the assigned schedule (online portion will be
available two weeks prior to the clinical portion
to paid registrants only)
• achievement of 75% on all online exams in order
to be permitted to participate in the clinical
component.
Due prior to the first clinical session
• copy of current Ohio dental hygiene license
• copy of current CPR/BLS certification
• completed health history form
• completed liability release form
• proof of HepB vaccination/immunity
*Information about these items is available online. You may
access the online course and contact the course instructors
using the login provided. Course modules will be available
two weeks prior to start of the clinical portion.
Instructors: Susan Helbling, BS, RDH
CRN: 40010
Saturday and Sunday
March 1 and March 2
8 a.m. - 4:30 p.m.
Fee: $1,095
In keeping with the guidelines established by the Ohio State Dental Board for licensure/certification, all individuals participating
in this lab course are required to provide appropriate documentation of immunization of hepatitis B and current certification in
CPR in order to participate in this dental continuing education course.
While Stark State College does not require additional immunizations, it is strongly recommended by the Centers for Disease
Control that all healthcare workers be immunized against vaccine-preventable diseases such as hepatitis B, influenza,
measles, mumps, rubella, and varicella. Because healthcare workers are considered to be at significant risk for acquiring
or transmitting these diseases in the course of their professions, the Allied Dental Health Department at Stark State College
supports this recommendation.*
*U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention (CDC),
Atlanta, Georgia 30333
Fire and Emergency Services
For specific information on dates and times
for the following three courses, contact
Bonnie Stich at bstich@starkstate.edu
or 330-494-6170, Ext. 4724
AHA Healthcare Provider/BLS CPR
The Basic Life Support (BLS) for Healthcare
Providers course is designed to provide a wide
variety of healthcare professionals the ability to
recognize several life-threatening emergencies,
provide CPR, use an AED, and relieve choking in
a safe, timely and effective manner.
Text required.
Instructor: Staff
CRN:40002
Tuesday, January 21
5 p.m. - 10 p.m.
Fee: $35 - plus text
EMT Basic Refresher
This EMT refresher course provides theory and
practical skills training and review at the EMT
level and follows the objectives as listed in the
Ohio Administrative Code. This course may be
used as
• a prerequisite for completion of National
Registry testing
• continuing education for NR or state of Ohio
• a transition course to maintain NR
certification
Instructor: Staff
CRN:40003
Monday/Wednesday/Friday
Fee:$150
Times scheduled with instructor
Paramedic Refresher/Transition Course
This course offers theory and practical skills
training and review at the paramedic level and
follows the objectives as listed in the Ohio
Administrative Code. This course may be used for
• a prerequisite for completion of National
Registry testing
• continuing education for NR or state of Ohio
• a transition course to maintain NR
certification
Instructor: Staff
CRN:40004
Tuesday, January 28
6 p.m. - 10 p.m.
Fee:$300
>>>>>>>
DON’T HAVE TIME TO ATTEND
A CLASS? NEED ONE-ON-ONE
INDIVIDUALIZED HELP?
Let one of our instructors come to your office
and work individually with you to help solve
your specific problems. $79 per hour.
For more information or to make
arrangements, call 330-966-5455.
[NEW!] Fire Instructor Course
This course enables a firefighter to become
an Ohio- certified fire instructor. Students will
supply their own materials, which are required,
including on the first day of class.
For additional information, contact
Jeff Magee at 330-305-6633, Ext. 2 or
jmagee@starkstate.edu
Prerequisites
• Valid fire certification
• Have not less than five years work experience as a firefighter including the three
years immediately prior to submission of an
application for instructor status
• Pass a written exam that demonstrates a
level of knowledge in firefighting consistent
with Firefighter Level II (Fire Instructor
Knowledge test)
Fire Instructor Knowledge tests will be
delivered
• Wed., Dec. 18, 2013 - 9 p.m.
• Mon., Dec. 23, 2013 - 9 p.m.
• Mon., Dec. 23, 2013 - 1 p.m.
• Sat., Jan. 18, 2014 - 9 a.m.
Candidates for the Fire Instructor Knowledge
test must register for the test a minimum of
10 calendar days prior to the test date.
Call 330-305-6633, Ext 2 to register.
Instructor: Rich Peterson
CRN:40013
February 1 - March 21
Monday and Wednesday
6 pm - 10 pm
Saturday, 8 am - noon
(Saturday, March 8,
8 a.m. - 5 p.m.)
Fee:$550
Professional Engineers
and Surveyors
Each class qualifies for five professional
development hours unless indicated otherwise.
Introduction to Renewable and Advanced
Energy Technologies and Distributed
Generation
Learn about leading renewable energy
technologies: hydro, solar, wind, wave, nuclear
and emerging technologies such as fuel cells.
We’ll discuss the concept of renewable and
advanced energy and how these forms of
energy are used in the U.S. and around the
world. In addition to a hands-on lab exercise,
the class will include a discussion of the basic
principles of thermodynamics, the definition of
efficiency, and a review of the latest developments in green energy technologies.
Class held at the Technology and Test
Center, Frank Avenue
Instructor: Susan Shearer
CRN:40028
Saturday, February 1
8 a.m. - 1 p.m.
Fee:$99
w w w. s t a r k s t a t e . e d u / c e
Introduction to Wind Energy
Learn about the wind energy industry and discuss the basic meteorology of wind, extraction
of energy from wind, wind farm development,
and the environmental and ecological impact of
wind energy. The class will include lab exercise
and a review of case studies involving wind
farms and residential wind turbines operating
in the U.S. and around the world.
Class held at the Technology and Test
Center, Frank Avenue
Instructor: Susan Shearer
CRN:40029
Saturday, March 8
8 a.m. - 1 p.m.
Fee:$99
Computer Technology
All computer course fees include manual or
textbook where applicable. Bring a USB flash
drive to save your work.
QuickBooks Pro 2013 - Level I
Here’s an introduction to one of the most
popular software packages for small businesses. We’ll cover topics that include setting
up a company on QuickBooks, learning how to
work with customer and vendor transactions
and setting up and interacting with the banking
functions of QuickBooks. There’ll also be a
light review of basic accounting. Fee includes
textbook, to be received during first class
session.
Instructor: Erich Dominik
CRN: 40022
Thursdays, March 20 and 27
9 a.m. - 4 p.m.
Fee:$245
QuickBooks Pro 2013 - Level II
Expand your knowledge of QuickBooks. You’ll
learn how to deal with physical inventory, sell
inventory, use payroll accounts, work with
balance sheet accounts, create estimates and
demystify some of the details of QuickBooks.
Fee includes textbook, to be received during
first class session.
Instructor: Erich Dominik
CRN:40023
Thursdays, April 24 and May 1
9 a.m. - 4 p.m.
Fee:$245
5
Online Training Programs
E-learn in the comfort of your own home
or office with our many online classes
Stark State is pleased to partner with several
providers of quality online courses.
You must have Internet access and
an email address.
Online, Instructor-led Classes
Classes begin each month. Each course runs
for six weeks and consists of 12 lessons,
supplemented by interactive quizzes, assignments, tutorials and online discussions. Get
your lessons and ask questions of your instructor at the time most convenient for you. Classes
are available in computer/Internet, business,
Web design, personal interest, courses for
teachers and many more.
For a full list of courses and descriptions
and fees, go to www.ed2go.com/ssct.
Online Career Training Programs
Begin a course whenever you want. You’ll
be assigned an instructor for one-on-one
assistance. All books, equipment and materials
are included in the course fee. Courses offered
• Administrative Medical Specialist
• Advanced Coding for the Physician’s Office
• Administrative Professional with Microsoft
Office Specialist
• Certified National Pharmaceutical
Representative
• Medical Transcription
• Six Sigma, Green Belt
• Six Sigma, Black Belt
• CompTIA A+ and Security + Certification
• CISCO - CCNA Certification Training
• Search Engine Optimization
• Starting and Running Your Own Business
• Bookkeeping the Easy Way with QuickBooks
• Webmaster Certification
• AutoCad 2007
• AutoCad 2009
For more course information and course
demos, go to www.gatlineducation.com.
• Medical Support
• Workforce Development
• Writing Skills
• Industrial Safety
• Computer Courses
For a full list of courses and to register,
go to http://coursecatalog.com/ssct
6
More than 700 online courses - whenever
and wherever you need them.
•Law/Legal
•Education
• Web Design
• IT Certifications
• Healthcare/Allied health
•Accounting/Finance/Tax
• Green/Renewable Energy
…and many more
For a complete list go to
ssct.theknowledgebase.org
More than 700 online courses available in
business, courses for K-12 teachers, eMarketing, green workplace, leadership and more.
Find your course online at
www.yougotclass.org/catalog.cfm/StarkState
Atención. Learn the Spanish you need to know
specifically for your occupation. Online classes
are now available in Spanish for Banking and
Spanish for Public Safety Officers. Courses
have 16 hours of instruction, are available for
six months and include a certificate of completion when finished. The courses incorporate
visual imagery (photos associated with words
and phrases), native speakers to hear proper
pronunciation, language tips, intuitive reading
exercises, interactive assessments to measure
your progress and comprehension and cultural
lessons. Course fee is $99.
For more information, go to
www.ProntoSpanish.com.
Exam Preparation
Online Courses
[ ONLINE COURSE ] ACT Exam Preparation
Prepare for the ACT exam at your own pace.
From effective test-taking strategies to
reviewing key skill areas, you will have the
confidence you need to reach your potential.
You can begin the online class at any time and
have five months access. Classes begin on the
15th day of each month, January through May.
Registration must be received five business
days prior to the start date.
Fee:$159
[ ONLINE COURSE ] GRE Exam Preparation
This online course will help you prepare for the
Graduate Record Exam (GRE) for grad school.
Learn effective test-taking strategies as well
as review key skill areas. Using Cambridge
Educational Services’ exclusive six-step
approach, you’ll not only be confident you’ve
done everything necessary to perform to
the best of your ability, but you’ll also have
the satisfaction of knowing that you’ve done
everything possible to advance your life plan.
Classes begin on the 15th day of each month,
January through May and students have five
months access. Registration must be received
five business days prior to the start date.
Fee:$159
[ ONLINE COURSE ] GMAT Exam Preparation
Prepare for the GMAT exam at your own pace
and learn how to beat the test. From effective
test-taking strategies to reviewing key skill
areas, you will have the confidence you need
to reach your potential. Classes begin on the
15th day of each month, January through
May and students have five months access.
Registration must be received five business
days prior to the start date.
Fee:$159
Industrial Maintenance
Basic Electricity for Maintenance
This is a noncredit course specifically designed
for current maintenance employees to update
and refresh their skills. No previous knowledge
of electrical systems is required. The participant
will learn electrical fundamentals, meters,
measurements, and basic electrical circuits and
how to troubleshoot those circuits in the work
place. Text required.
Instructor: Bill DeCoste
CRN: 40037
Tuesdays and Thursdays
February 11 - March 18
4:30 - 7:30 p.m.
Fee: $629
Troubleshooting Machine Controls I
This noncredit course is designed specifically
for current maintenance employees to update
and refresh their skills. Previous knowledge of
electrical systems or Basic Electricity for Maintenance is required. The participant will learn
how to troubleshoot and properly wire motor
control circuits, pilot devices, limit switches and
other industrial devices. Text required.
Instructor: Bill DeCoste
CRN: 40038
Tuesday and Thursday
March 25 - April 24
4:30 - 7:30 p.m.
Fee: $639
Troubleshooting Machine Controls II
This noncredit course is designed for current
maintenance employees to update and refresh
their skills. Previous knowledge of electrical
motor control systems or Troubleshooting Motor
Controls I is required. The participant will learn
how to troubleshoot complex electric motor
controls including timers, reversing starters,
PLC interfacing and reduced voltage starting.
Instructor: Bill DeCoste
CRN: 40039
Tuesdays and Thursday
January 7 - February 6
4:30 - 7:30 p.m.
Fee: $639
— OR —
CRN: 40040
Mondays and Wednesdays
January 6 - February 10
(no class January 13)
4:30 - 7:30 p.m.
Fee: $639
— OR —
CRN: 40041
Tuesdays and Thursdays
April 29 - June 5
4:30 - 7:30 p.m.
Fee: $639
Instructor: Jim Hardin
CRN:40045
Mondays and Wednesdays
February 17 - March 24
6 - 9 p.m.
Fee: $499
Troubleshooting PLCs – the Basics
Low-Pressure Boiler Operations
This course offers basic information and counts
for 1,000 of the state-required hours needed
to take a high-pressure (15 psi or more) boiler
operator’s test. Content includes boiler feed
pumps and fuel feeders, feedwater heaters
and feedwater treatment and fuel combustion.
Participants will take sample tests to prepare
for the state exam. Text required
Instructor: Jack Campbell
CRN:40047
Mondays and Wednesdays
February 11 - April 22
(no class Feb. 17 and April 1)
5:30 - 9:30 p.m.
Fee: $999
OSHA 10-hour Safety – General Industry
OSHA 1910.146 – Confined Spaces
This class will cover low-pressure boiler (15 psi
or less) operation and construction, along with
maintenance and safety procedures. The class
counts for 1,400 of the state-required experience hours needed to take a low-pressure
boiler operator’s test. Participants will take
sample tests to prepare for the state exam.
Text required.
Instructor: Jack Campbell
CRN:40046
Mondays and Wednesdays
February 11 - April 2
(no class Feb. 17)
5:30 - 9:30 p.m.
Fee:$599
Troubleshooting PLCs – Systems
High-Pressure Boiler Operations
Hydraulic/Pneumatic Troubleshooting I
This is a noncredit course custom-designed
for maintenance personnel. The participant
will learn basic safety, symbols, fluids,
accumulators, on-off control valves, cylinders,
and motors using hands-on troubleshooting
techniques. Text required.
Instructor: Jim Hardin
CRN: 40044
Mondays and Wednesdays
January 6 - February 5
6 - 9 p.m.
Fee: $599
Hydraulic/Pneumatic Troubleshooting II
This is a noncredit course designed for
maintenance personnel. The participant will
learn basic safety, symbols, electro-hydraulics,
plus an introduction to proportional control
using hands-on lab techniques.
This safety orientation course meets the
requirements of the Occupational Safety and
Health Administration (OSHA) 10-hour training
requirement. Students are given a general
overview of the most common hazards
encountered on job sites and taught related
safety guidelines to avoid them. Students are
introduced to the OSHA standards and requirements as they pertain to general industry.
Students that attend the required time and
pass a final examination will receive their
OSHA 10-hour Safety - General Industry Card.
Instructor: Carl Moore III
June 27 and June 28
Friday 8 a.m. - 4:30 p.m.
Saturday 8 a.m. - noon
Fee:$175
Industrial Service Technician Certificate Program
Earn a certificate in industrial maintenance. Select the track that most meets your needs
and those of your company, or work towards earning a certificate in each track.
Electrical
IADC Rig Pass with SafeLAND USA and
SafeGULF Training
This fully accredited, nationally recognized safety
training course provided by the International
Association of Drilling Contractors will address
the health, safety and environmental training and
requirements for oil and gas service contractors
and exploration and production employees both
on shore and off shore. This course covering an
industry-standardized curriculum will give you
basic knowledge of
• work site safety
• overview of government agencies and
applicable regulations
• employee responsibilities
• environmental protections
• incident reporting procedures
After completing the course, you’ll be issued a
completion card with an identification number,
the IADC Rig Pass, SafeLAND USA and SafeGULF
logos. The identification number will be entered
into the national databases for IADC Rig Pass,
SafeLAND USA and SafeGULF.
Instructors: Scott Williams and Carl Moore
CRN: 40030
Friday, January 31
7:30 a.m. - 5 p.m.
Fee: $175 (includes lunch)
— OR —
CRN:40031
Friday April 4
7:30 a.m. - 5 p.m.
Fee: $175 (includes lunch)
This is a noncredit course for current
maintenance employees to update and refresh
their skills. Previous knowledge of electrical
systems and Troubleshooting Motor Controls
I is required. The participant will learn how
to troubleshoot and properly wire PLCs,
identify and properly locate defective inputs and
outputs and be introduced to RSLogix500 software, all using Allen-Bradley Micrologix1000
PLCs. Text required.
Instructor: Butch Powell
CRN: 40042
Tuesdays and Thursdays
February 18 - March 20
5:30 - 8:30 p.m.
Fee: $729
This is a noncredit course for current maintenance employees to update and refresh their
skills. The participant must be familiar with
RSLogix500 and Micrologix1000 PLCs or have
taken Troubleshooting PLCs – The Basics. We’ll
look at troubleshooting small conveyor systems
controlled by Microlgix1000 PLCs using
RSLogix500 software. Text required.
Instructor: Butch Powell
CRN: 40043
Tuesdays and Thursdays
April 1 - May 1
5:30 - 8:30 p.m.
Fee: $499
Oil and Gas Exploration
Mechanical
Automation
Basic Electricity for Maintenance
Basic Electricity for Maintenance
Electrical PLUS Mechanical tracks
Troubleshooting Machine Controls I
Troubleshooting Machine Controls I
Troubleshooting PLCs -Systems
Troubleshooting Machine Controls II
Hydraulics/Pneumatics Troubleshooting II
CNC Programming
Hydraulics/Pneumatics Troubleshooting I
Mechanical Drives (credit class)
CNC Maintenance or CNC
Operations or Servo Systems
Troublesooting PLCs - The Basics
Programming Variable
Frequency Drives
Blueprint Reading for the
Machine Trades
This course offers chemical, biological, and
physical principles as they apply to safety while
working in confined spaces, including
• OSHA’s confined space standards, scope
and application
• determining if a space is “permit required”
• rescue and emergency services
• the responsibilities of contractors,
attendants, supervisors, entrants
• when and how to utilize OSHA’s “alternative
entry” and “reclassification”
• related equipment
Students will enter confined spaces inside and
outdoors. Students must wear appropriate
clothing: long pants, shoes or work boots;
no sandals or flip-flops, athletic shoes are
acceptable; bring rain gear.
Students receive a 12-hour confined space certificate upon completion of this course. The course
will be submitted to the Ohio EPA for contact hour
approval for water and wastewater operators.
Instructors: Scott Williams and Carl Moore
CRN: 40032
May 23 and May 24
Friday 8 a.m. - 5 p.m.
Saturday 8 a.m. - noon
Fee: $297 (includes lunch)
— OR —
June 5 and June 6
Friday 8 a.m. - 5 p.m.
Saturday 8 a.m. - noon
Fee: $297 (includes lunch)
7
License Renewal Workshop
for Water and Wastewater
Operators
Drinking Water and Wastewater 2014
Regulatory Update
This course will cover regulatory rule updates
that occurred during 2013 and rules expected
to be proposed or become effective during
2014. These will include the revised total
coliform rule, new plan approval procedures,
lead and copper rule updates, harmful algal
blooms a Greenbook update, PTI for sewage
disposal systems at campgrounds, and the new
storm water rule. The course will be submitted
to Ohio EPA for contact hour approval.
Course may be approved for a minimum of
6.5 contact hours.
Instructor: Scott Williams, CHMM
CRN:40050
Tuesday, February 7
7:30 a.m. – 4:30 p.m. Fee: $145 (includes lunch)
Water and Wasterwater Math Problems
This course will assist students desiring to
take the Class 1, Class 2 or Class 3 water or
wastewater certification examinations and will
be a refresher for current water and wastewater plant operators. Course will be submitted to
Ohio EPA for the approval of contact hours. The
course will cover significant figures, conversion
problems, ratio calculations, percent calculations, area and volume problems, density
calculations, specific gravity, pressure, detention time calculations, weir overflow, flow and
velocity, pump discharge calculations, sludge
and biosolids pumping, pumping horsepower
and efficiency calculations, chlorine dose,
demand and residual problems, chemical feed
calculations, BOD loading calculations, BOD
removal calculations, COD calculations, lime
neutralization, population loading calculations,
basic electricity, detention time, hardness,
water consumption, and calculations for wells.
Instructor: Scott Williams, CHMM
CRN:40052
Friday, March 7
8 a.m. - 4 p.m.
Fee: $145 (includes lunch)
Real Estate
Home Inspection Institute
The Home Inspection Institute in Cincinnati
has trained more than 3,000 home inspectors
nationwide. In just 40 hours, get the knowledge
and skills necessary to open your own home
inspection business. Tony Brueneman returns
to Stark State to guide you through tools,
techniques, ethics, necessary information
about residential construction and mechanical
systems, report writing, legal liability and
contracts, marketing and business start-ups
and much more. You’ll participate in three
on-site home inspections. Text, materials and
8
a certificate from the Home Inspection Institute
are included in the course fee.
Instructor: Tony Brueneman,
Home Inspection Institute
CRN: 40017
Tuesday - Saturday
April 8 April 12
8 a.m. - 6 p.m. (Tues.-Fri.);
8 a.m. - noon (Sat.)
Fee: $995
The following four courses are required
to take the Ohio real estate license exam.
Principles and Practice of Real Estate
This course includes an overview of the
economic and social impact of real estate, the
real estate market, market analysis, classification of property rights, contracts, deeds, and
conveyances, mortgages and deeds of trust,
leases and leasing, and supplemental real
estate instruments and liens. Text included.
Instructor: Jerry Mosley
CRN: 40018
Tuesdays and Thursdays
April 8 - May 8
6 pm - 10 p.m.
Fee: $299
Real Estate Law
The class curriculum includes Law of Agency
as applied to brokers and salespersons, Law of
Fixtures, estates (including leases), mortgages
and liens, closing transactions, and licensing
and zoning laws in Ohio. Text included.
Instructor: Jerry Mosley
CRN: 40019
Tuesdays and Thursdays
May 13 - June 12
6 pm - 10 p.m.
Fee: $299
Real Estate Finance
The class curriculum includes methods, instruments and procedures involved in financing
real estate, and characteristics of mortgages,
government policies on finance. Text included.
Instructor: Toby Hoy, PhD, MBA, MTAX,
MSRE, CRMS
CRN: 40020
Mondays and Thursdays
February 24 - March 10
6 pm - 10 pm
Fee: $199
Real Estate Appraisal
The class curriculum includes the fundamentals
of appraising real estate, the nature of real
property and basic principles of its value, appraisal process, neighborhood and site analysis,
building costs, depreciation, capitalization and
appraisal reports. Text included.
Instructor: Toby Hoy, PhD, MBA, MTAX,
MSRE, CRMS
CRN: 40021
Mondays and Thursdays
March 13 - March 27
6 pm - 10 pm
Fee: $199
Health and Recreation
Orientation to Fitness Training
This FREE one-hour personal fitness training
orientation provides information for anyone
interested in the fitness profession or in
becoming a fitness trainer. This lecture includes
a brief overview of the industry trends while
allowing ample time for a question and answer
session. Topics include personal training, group
exercise, fitness for seniors and children and
aqua fitness.
CRN: 40016
Saturday, February 8
9 am - 10 am Free: registration required
Personal Trainer National Certification
Be a part of what Fortune magazine and
ABC News call the fourth-hottest job in the U.S.
This challenging eight-week course (62-hours)
program and is comprised of 16 hours of
lecture, 16 hours of hands-on practical training
and a 30-hour internship that networks many
graduates into a job; the national exam is held
on the ninth week. W.I.T.S. is the only major
certifying organization in the country providing
comprehensive practical training and internship
components. Topics include biomechanics,
exercise physiology, fitness testing, equipment
usage and health assessment. CPR/AED certification is required to receive the certificate.
W.I.T.S. is an approved CEU provider for the
Board of Certification for Athletic Trainers, the
American Occupational Therapy Association,
National Certification Board for Therapeutic
Massage & Bodywork, Veterans Training and
Education, the International Association of Continuing Education and Training. The American
Council on Education has recommended three
undergraduate academic credits for this course.
Instructor: Staff, World Instructor Training Schools
CRN: 40015
Saturdays, March 1 - May 3
(no class April 19)
9 a.m. - 2 p.m.
Fee: $734 (required textbook
not included)
Call 888-330-9487 to order and start reading
immediately (www.witseducation.com).
Emergency Preparedness Training
Awareness is the best tool in your toolbox when
a major disaster strikes and this course will
ready you and your entire family to be prepared.
Learning the basics – assembling a disaster kit,
putting a communications plan in place, making
arrangements for individuals with disabilities,
and using technology – during a disaster can
save lives and property and help you and your
community get back to normalcy. How ready
are you?
Instructor: Diana Tsenekos
CRN: 40033
Thursdays
February 13 - March 6
(no class February 18)
5:30 pm - 7:30 pm
Fee: $159
REGISTRATION AND PAYMENT
Students must register and pay for classes five business days before the class begins.
Early registration is recommended for sufficient enrollment to conduct classes.
CLASS LOCATION Unless otherwise noted, all classes are held at the Corporate Services and Continuing
Education Center, located in the Hoover District at 265 E. Maple Street, North Canton, OH 44720.
CERTIFICATES OF COMPLETION Stark State College awards students with certificates for satisfactory
completion of continuing education offerings. The College follows national guidelines for continuing education and is a member of the Ohio Continuing Higher Education Association (OCHEA). In order to achieve
satisfactory completion, students must attend at least 80% of the continuing education course/offering.
WITHDRAWAL AND REFUND POLICIES Continuing education students who wish to withdraw
from classes before classes begin must notify the Workforce and Economic Development Office,
330-966-5455, at least two days before the first day of class. Refunds will be mailed within 30 days
after withdrawals. A $7 processing fee will be deducted from all refunds. NO REFUNDS will be made
after the first class session.
CANCELLATIONS Stark State College reserves the right to cancel a course due to insufficient enrollment,
in which case a full refund will be mailed to you within 30 days.
PARKING Free, lighted parking is available across E. Maple St from the Continuing Education Center.
For continuing education classes on the main campus, students will receive parking permits.
ROOM ASSIGNMENTS Room number for classes will be posted in the Continuing Education Center
lobby on the first day of the class.
TEXTBOOKS Most continuing education classes will provide required textbooks at the first class, unless
otherwise noted in the class description. Please note whether you are required to purchase the textbook
at the college bookstore or if it is included with the class fees.
COMPANY DISCOUNTS Companies enrolling three or more employees into the same class will receive
a 10% discount. Discount does not apply to credit courses.
SENIOR CITIZENS Senior citizens (60+) will receive a 15% discount on course fees by presenting a copy
of their Golden Buckeye Card at the time of registration. This discount applies to “in person” registrations
only and does not include special senior citizen classes or company-paid registrations.
TAX DEDUCTION If the purpose of attending workshops or classes is to help you maintain or improve
your skills relating to employment or business, expenses for fees and books may be tax-deductible
according to I.R.C. Reg. 1.162-5. You may also qualify for a Lifelong Learning tax credit. Consult your
tax advisor for more information.
Get a seat in the classes you want
FOUR EASY WAYS
to register
>> MAIL-IN
Complete registration form and mail to
Corporate Services and Continuing
Education Center
265 E. Maple Street
North Canton, OH 44720
>> FAX-IN
Fax your completed registration form to
330-244-8996
>> SCAN-IN
Email your completed registration form to
continuingeducation@starkstate.edu
>> WALK-IN
register in person
Corporate Services and Continuing
Education Center
265 E. Maple Street
North Canton, OH 44720
Monday-Friday 8 a.m. - 4 p.m.
330-966-5455
REGISTRATION FORM Form may be duplicated for additional registrations
[ CHECK PAYMENT TYPE ]
S.S No. ______________ - ______________ - ______________ Today’s date ________________________________
Continuing education and non-credit students are
not required to pay the application fee required
for credit students.
Make checks payable to: Stark State College
Name ___________________________________________________________________________________________
Last
First
Middle
Home address _____________________________________________________________________________________
City/State/Zip ____________________________________________________________ County ___________________
Note: No refunds will be given after class begins.
q Invoice Company - P.O. No. ________________________
q Check (enclosed) - Check No. _____________________
Business name _____________________________________________________________________________________
q Money Order (enclosed)
q Debit Card
Business address ___________________________________________________________________________________
q VISA
q Discover
City/State/Zip ____________________________________________________________ County ___________________
Total $ _________________________________________
Date of birth _____________________________________
Home phone ______________________________________ Work phone _______________________________________
E-mail address ____________________________________
CRN Course Title
q MasterCard
Debit/Credit Card No. ______________________________
Expiration Date ___________________________________
______________________________________________
Name on card
________________________________________________________________________________________________
Card billing address __________________________________
________________________________________________________________________________________________
City/State/Zip ______________________________________
________________________________________________________________________________________________
_________________________________________________
Signature (required for debit/credit card payment)
________________________________________________________________________________________________
________________________________________________________________________________________________